Psychosocial Adjustment of Males on Three Types of Dialysis

The objective of this study was to describe the health-related quality of life (HRQOL) of patients on different forms of treatment for endstage renal failure in such a way that the data could be used in a cost-utility analysis of renal failure treatment in Britain. Twenty-four British renal units participated in this study. 997 adult dialysis and transplant patients were randomly selected from these units using the European Dialysis and Transplant (EDTA) Registry Database. The Health Measurement Questionnaire was completed by 705 of the 900 patients who were alive at the time of the survey (response rate of 78%). The HRQOL data were linked with comorbidity data and with clinical data from the EDTA Registry. Compared to the general population, patients with endstage renal failure experienced a lower quality of life. Many factors contributed to this, but uncertainty about the future and lack of energy emerged as key components. Transplant recipients reported better HRQOL than dialysis patients, they reported fewer problems with physical mobility, self-care, social and personal relationships and usual activities. They also experienced significantly less distress, while dialysis patients reported problems with depression, anxiety, pain and uncertainty about the future. These differences remained after controlling for age and comorbidity.

The authors examine the relationship between psychosocial factors and factors and survival of patients with chronic renal failure, while considering simultaneously the influence of parameters of physiologic functioning. Psychosocial and physiologic variables selected for discriminant analysis were extracted from data on 285 home-dialysis patients in Ontario, Canada. This analytical procedure defined which variables best discriminated between the survivor and nonsurvivor groups. The findings suggest that demographic and psychosocial factors may be more important than physiologic variables in determination of survival on home dialysis. The severity and type of depression is of particular importance to outcome.